Dr. Robert Bossarte

MORGANTOWN, W.Va. — Researchers at West Virginia University are hopeful that a $13.3 million award will lead to several answers surrounding high rates of clinical depression in rural America.

Dr. Robert Bossarte, an associate professor in the WVU School of Public Health, wants more than just answers about why rates are high; he wants to use the award from the Patient-Centered Outcomes Research Institute to figure out how to bring those numbers down while simultaneously bringing mental health awareness and treatment into the light of day.

“From our research on both for people living with depression in rural areas and even outside of rural areas, it means we have an opportunity to identify another treatment option for persons with depression,” he said.

Bossarte wants to explore an entirely new model for treatment — one that utilizes technology to make mental health treatment a more private affair and much more accessible.

“We know that depression is prevalent,” he said. “We know that treatment is more difficult in rural areas. We know we face challenges here in West Virginia, and the model of treatment that we’re going to test has the promise of providing a new treatment option for people with depression that will overcome a lot of the traditional barriers we see with getting healthcare for mental health disorders.”

Those barriers begin with the stigma surrounding depression — what it is, what it means to be treated for depression, and what it means to overcome the illness.

“We know that, sometimes, good people are afraid that they’ll be looked at negatively if people know that they’ve been diagnosed with depression or think that they’re getting mental health care,” Bossarte said. “Then that becomes the reason to not go get care.”

That’s because, according to Bossarte, the disease remains widely misunderstood by those who don’t someone suffering from regular symptoms of depression.

“It means persistent depression,” he said. “Something that affects your mood and your mood state — your behavior for a specific period of time — for two weeks or more. We do know that with major depression and persistent depression, it can last for months.”

Depression can be caused by chemical and environmental means, a reaction to loss, genetics, and several other factors or combination of factors, Bossarte said. It isn’t simply ‘feeling sad’ and it can’t simply be treated through sheer will.

“And then you can have multiple recurring cycles of minor depression or low-level or lower-grade depression that can last for years,” Bossarte said.

In many ways, Bossarte said it is a vicious cycle with a potentially deadly ending.

“Depression is one of the most strongly associated psychiatric disorders with suicide,” he said. “Our interest, ultimately, is trying to improve the lives of people living with mental disorders or affected by depression.

He continued: “And a lot of that is trying to reduce the rate of suicide.”

The cycle of depression and mental illness in rural America — generally more prevalent than in urban zones — could be fueled, at least in part in Bossarte’s mind, by stigmas that prevent people from seeking treatment — leading to undiagnosed and untreated mental illness, which in turn can lead to issues with suicide, drug overdoses, and addiction.

“It could be that it is more common among people in that (rural) area — simply that it happens more frequently — or that it persists longer than it does in areas where treatment is more available,” he said.

So, Bossarte has a plan. He will use the $13.3 million to study three treatment strategies that could favorably impact patient outcomes in rural America — study the use of antidepressant medication, combine antidepressants with unguided cognitive behavior therapy provided over the internet, and to study the use of antidepressant medication with guided online cognitive behavior therapy.

And, with every single option, it is some form of therapy that a patient can engage in from home — partially because the study assumes that treatment options will be less readily available for rural residents. The study also posits the idea that a more comfortable, private treatment style can have benefits in dealing with those fearful of public stigmatization.

“One of our hopes for this project is that it will demonstrate this new model, one that you can take in your home, with or without the assistance of a coach,” Bossarte said.

During the unguided therapy, patients will follow steps provided on a website to determine what exacerbates their depression symptoms and change how they respond to those triggers.

“It’s really to work with the population that’s affected by mental disorders and depression to help them improve their lives, to listen to them and understand their preferences, to work with them to arrive at a better solution than we currently have for residents of West Virginia and other rural areas,” Bossarte said.

Lowering rates of depression, he hopes, will lead to those lower rates of suicide, addiction, and overall mental health problems.

“Our real hope is that we can improve people’s lives by providing a new treatment option by helping people more rapidly figure out which option is best for that person so that they don’t have to go through the experience of trying one or trying two and not feeling better, because we know that it can attribute to a sense of hopelessness in a person.”

Combating that hopeless is the key, according to Bossarte. Giving patients and clinicians additional options for treatment, Bossarte hopes, will be a part of a wider solution.

“The work that we’re doing here and now can improve the lives, for generations, of people to come. We are, of course, talking about the individual’s life who is working with this now. But we’re not just talking about that, we’re talking about their children and their grandchildren.”

A patient-advisory committee will assist the study, which features 8,000 depression patients currently living in West Virginia.

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